Suaahara Impact Evaluation: End-line Survey

Phase 3

Completed

• Conditions: Nutritional Stunting; Feeding Behavior
• Interventions: Behavioral: Health and family planning; Behavioral: Nutrition; Behavioral: Agriculture and homestead food production; Behavioral: Water, sanitation, and hygiene

• Registration Number: NCT05448287
• Lead Sponsor: University of South Carolina

Brief Summary

Suaahara's primary aim is to reduce the prevalence of stunting, wasting, and underweight among children under 5 years of age and to reduce the prevalence of anemia among women of reproductive age and children 6-59 months of age. For this, the program uses a multi-sectoral approach to achieve four key intermediate results: 1) improved household nutrition, sanitation, and health behaviors; 2) increased use of quality nutrition and health services by women and children; 3) improved access to diverse and nutrient-rich foods by women and children; and 4) accelerated roll-out of the Multi-Sectoral Nutrition Plan (MSNP) through strengthened local governance

Detailed Description

The Government of Nepal and development partners have prioritized multi-sectoral (integrated) nutrition as a key development agenda. The Suaahara program funded by the United States Agency for International Development is one of the programs that support the Government of Nepal's multi-sectoral nutrition plan. It aims to reduce maternal and child under-nutrition over a period of ten years, spanning two phases: Suaahara I (2011-2016) and Suaahara II (2016-2021). Initially launched in 20 of 75 districts, the program has scaled-up to 42 of 77 districts that span across Nepal's three agroecological zones of mountains, hills, and terai.

Suaahara I was led by Save the Children International in partnership with Helen Keller International, Johns Hopkins University Center for Communications Programs, Jhpiego, Nepal Water for Health (NEWAH), the National Promotion and Consultancy Service, and the Nepali Technical Assistance Group (NTAG). Suaahara II was led by Helen Keller International in partnership with Cooperative for Assistance and Relief Everywhere, Inc., Family Health International 360), he Nepali Technical Assistance Group, Digital Broadcast Initiative Equal Access, Environmental and Public Health Organization, and Vijaya Development Resource Center.

Suaahara's primary aim is to reduce the prevalence of stunting, wasting, and underweight among children under 5 years of age and to reduce the prevalence of anemia among women of reproductive age and children 6-59 months of age. For this, the program uses a multi-sectoral approach to achieve four key intermediate results (IRs): 1) improved household nutrition, sanitation, and health behaviors; 2) increased use of quality nutrition and health services by women and children; 3) improved access to diverse and nutrient-rich foods by women and children; and 4) accelerated roll-out of the MSNP through strengthened local governance. Suaahara interventions span health and family planning (FP), nutrition, agriculture/homestead food production (HFP), and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors. Suaahara's conceptual framework illustrates the paths by which the program activities linked to desired outcomes achieve Suaahara II objectives.

Study Timeline

• Study First Submitted: 2022-06-16
• Study Start: 2022-06-17
• Study First Submitted QC: 2022-07-02
• Study First Posted: 2022-07-07
• Primary Completion: 2022-09-30
• Study Completion: 2022-09-30
• Status Verified: 2023-01
• Last Update Submitted: 2023-01-04
• Last Update Posted: 2023-01-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 2480

Inclusion Criteria

• At the household level, the primary respondents are mothers of children under 5 years of age from the selected households.
• Other survey respondents include a primary male (or female, if male unavailable) household decision-maker, and a grandmother of children under 5 years of age residing in the household.
• The Female Community Health Volunteer and health workers are also Suaahara beneficiaries, as the program explicitly aims to improve their knowledge and skills.

Exclusion Criteria

• None.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Nutrition	Suaahara interventions span health and family planning; nutrition; agriculture/homestead food production; and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors.
Intervention	Health and family planning	Suaahara interventions span health and family planning; nutrition; agriculture/homestead food production; and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors.
Intervention	Water, sanitation, and hygiene	Suaahara interventions span health and family planning; nutrition; agriculture/homestead food production; and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors.
Intervention	Agriculture and homestead food production	Suaahara interventions span health and family planning; nutrition; agriculture/homestead food production; and water, sanitation and hygiene (WASH). Diverse social and behavior change communication interventions are used, primarily to generate demand for access to improved services and to motivate households to adopt optimal health, nutrition, and WASH practices. All Suaahara interventions are supported by a crosscutting theme of gender equality and social inclusion (GESI), in part by targeting women and disadvantaged groups and conducting activities that address GESI-related barriers to optimal health, nutrition, and WASH behaviors.

Primary Outcome Measures

Name	Time	Method
Stunting	Over the 24 hours of the day of data collection	Prevalence of height or length for age zscore \< -2
Child dietary diversity (Indicators for Assessing Infant and Young Child Feeding Practices)	Over the 24 hours of the day before data collection	Mean score, range 0 to 8, higher is better
Anemia among children aged 6-59 months	Over the 24 hours of the day of data collection	Prevalence \< 11 g/dl
Wasting	Over the 24 hours of the day of data collection	Prevalence of weight for length for height zscore \< -2
Maternal anemia	Over the 24 hours of the day of data collection	Prevalence \< 12 g/dl
Maternal dietary diversity (Minimum Dietary Diversity for Women)	Over the 24 hours of the day before data collection	Mean score, range 0 to 10, higher is better
Underweight prevalence	Over the 24 hours of the day of data collection	Prevalence of weight for age zscore \< -2
Maternal underweight	Over the 24 hours of the day of data collection	Prevalence of body mass index \< 18.5
Accurate health, nutrition, and water, sanitation, and hygiene knowledge and skills among Female Community Health Volunteers and health workers from 52 items	Over the 24 hours of the day of data collection	Prevalence \> 80% correct from 52 items

Secondary Outcome Measures

Name	Time	Method
Maternal hemoglobin	Over the 24 hours of the day of data collection	Mean in g/dl
Height for age	Over the 24 hours of the day of data collection	Mean z-score
Weight for height	Over the 24 hours of the day of data collection	Mean z-score
Maternal body mass index	Over the 24 hours of the day of data collection	Mean
Maternal minimum dietary diversity (Minimum Dietary Diversity for Women)	Over the 24 hours of the day before data collection	Prevalence \> 4 food groups of 10
Child minimum dietary diversity (Indicators for Assessing Infant and Young Child Feeding Practices)	Over the 24 hours of the day before data collection	Prevalence \> 4 food groups of 8
Weight for age	Over the 24 hours of the day of data collection	Mean z-score
Child hemoglobin	Over the 24 hours of the day of data collection	Mean in g/dl
Knowledge score on core infant and young child feeding practices among mothers from 15 items	Over the 24 hours of the day of data collection	Mean score, range 0 to 15, higher is better
Female Community Health Volunteers and health workers with ideal practices related to health, nutrition, and water, sanitation, and health from 52 items	Over the 24 hours of the day of data collection	Prevalence \> 80% correct from 52 items
Knowledge score on health and water, sanitation, and hygiene practices among mothers from 37 items	Over the 24 hours of the day of data collection	Mean score, range 0 to 37, higher is better

Trial Locations

Locations (1)

Helen Keller International; 🇳🇵 Kathmandu, Nepal